Healthcare Provider Details

I. General information

NPI: 1790632669
Provider Name (Legal Business Name): RECREATE LIFE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2026
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5342 OLDEN PORTER RD
PENDLETON SC
29670-8926
US

IV. Provider business mailing address

5342 OLDEN PORTER RD
PENDLETON SC
29670-8926
US

V. Phone/Fax

Practice location:
  • Phone: 864-958-0474
  • Fax:
Mailing address:
  • Phone: 864-958-0474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: SHAVOLKIA CHANTE MCADAMS
Title or Position: OWNER
Credential: LPC, M.ED.
Phone: 864-958-0474